Maternal Mortality in India: Progress, Challenges, and Strategies for Elimination

Remarkable Progress

India has achieved a 70% reduction in maternal mortality ratio (MMR) from 2000 to 2020, dropping from 384 to 97 per 100,000 live births. This remarkable progress places India on track to meet the SDG target of 70 by 2030.

What Worked

Institutional Delivery Coverage

The Janani Suraksha Yojana (JSY) — India's conditional cash transfer scheme for institutional delivery — has been transformative:

• Institutional birth rate increased from 39% (2005-06) to over 88% (2019-21)
• Particularly effective in low-performing states
• Reduced financial barriers to facility-based care

Emergency Obstetric Care

Strengthening of first referral units and emergency obstetric care services at district hospitals has been critical. The launch of:

• 24x7 labor rooms with trained staff
• Blood storage facilities at first referral units
• Referral transport systems (102/108 ambulance services)

Skilled Birth Attendance

Training and deployment of nurse-midwives and skilled birth attendants has improved quality of care during delivery and the immediate postpartum period.

Persistent Challenges

Regional Disparities

MMR varies dramatically across states:

• Kerala: 29 per 100,000 (well below SDG target)
• Assam: 195 per 100,000 (nearly 7 times Kerala's rate)
• States with high MMR share common challenges — poor infrastructure, shortage of specialists, and low female literacy

Quality of Care

While institutional delivery rates are high, quality remains variable. Studies reveal gaps in:

• Adherence to evidence-based practices
• Respectful maternity care
• Postpartum monitoring and follow-up

The Road to Elimination

1. Focus on high-burden districts: Targeted interventions in aspirational districts
2. Quality improvement: LaQshya program for labor room quality certification
3. Postpartum care: Strengthening 48-hour and 7-day postpartum follow-up
4. Family planning: Addressing unmet need for contraception